Month: January 2010

Back to the (Recent) Past

Seth Roberts4 Comments

My work is all about how the past was better for us. People stood more; so they slept better. They ate more animal fat; so they slept better. They saw more faces in the morning and fewer faces late at night, so their mood was better. Their food had more bacteria growing on it, so their immune and digestive systems worked beter. And so on.

Past meaning 100,000 years ago. In Beijing, I am moving from one apartment (A) to another apartment (B). Apartment A is in a modern building, Apartment B is in a building maybe 40 years older. To my surprise, Apartment B is clearly better than Apartment A. The biggest improvement is that Apartment B has all-incandescent lighting. Apartment A was all-fluorescent. Exposure to fluorescent light in the evening can interfere with the faces-mood effect because it can resemble sunlight. Incandescent lamps are so much cooler than the sun that the light they emit is very different. Another improvement is that Apartment B, unlike Apartment A, has a sun deck. So it’s easy to get lots of sunlight in the morning — important for sleep and for the faces-mood effect. The third improvement is that Apartment B, like Apartment A, is on the sixth floor — but Apartment B is a walk-up. Walking up six flights of stairs will tire out my legs so that when I do one-legged standing (to sleep better) I won’t have to stand as long before getting exhausted. When I lived in Apartment A I could have taken the stairs, but I never did.

False Alarm

Seth Roberts1 Comment

Today I flew from Tokyo to San Francisco. Just before boarding there was a level of security I hadn’t encountered before: Every passenger’s carry-on luggage was searched and every passenger was wand-scanned. Then my name was called. “Please come to the check-in desk.” I went to the check-in desk. “Are you Mr. Roberts?” Yes. The woman who had asked me that started typing. “Why did you call my name?” I asked. No answer. I asked again. No answer. Eventually I figured out I’d been summoned to the check-in desk to be offered a better seat, for which I hadn’t asked and for which I was very grateful. The airline was ANA.

Two Chinese Idioms

Seth Roberts2 Comments

dao ye. dao means to buy in one place and sell in another (an example of how Chinese has far more verbs than English). The literal meaning of ye is grandpa but it is humorously used to praise someone. The dao ye are people who buy little stuff, such as clothes, in Southern China, where it’s made, and sell it in Beijing. Probably on the sidewalk.

chao fang tuan. Chao means stir-fry (fast cooking), fang means houses or apartments, and tuan means group (of people). The chao fang tuan are those who speculate in real estate. They buy a house or apartment and sell it quickly. “Everyone in China hates the chao fang tuan,” said my friend.

Value of Blood Glucose Self-Monitoring

Seth Roberts7 Comments

In the 1960s, Richard Bernstein, an engineer and a Type 1 diabetic, pioneered the use of blood glucose self-monitoring. Using it, he was able to greatly improve his glucose control and thereby his health. No one doubts it helps Type 1 diabetics. With Type 2 diabetics, whose blood glucose is better controlled, the benefit is obviously less clear — but to many Type 2 diabetics, unmistakable.

A recent literature review, however, begged to differ:

Contrary to the widely-held belief, there is no proof that non-insulin-dependent patients with type 2 diabetes benefit from glucose self-monitoring. Moreover, it remains unclear whether an additional benefit is displayed by the blood test compared to the urine test or vice versa, in other words, whether one or other of the tests might offer an advantage to patients. The current data are quantitatively and qualitatively inadequate: the few trials that are suitable for investigating these questions have not included or have insufficiently reported many outcomes important to patients. Owing to their short duration, it is also not possible to draw any conclusions on the long-term benefit of glucose self-monitoring. This is the conclusion of the final report of the Institute for Quality and Efficiency in Health Care (IQWiG), [which is in Germany,] published on 14 December 2009.

Which is even more ridiculous than dermatologists concluding that acne isn’t due to diet. At a forum for diabetics, the report was roundly criticized:

Telling a Type 2 Diabetic not to measure his/her BG is like telling an overweight person not to weigh themselves…Ignorance is NOT bliss.

Totally agree! I was told by a nurse the other week not to measure my blood pressure at home as ‘home testing can cause patients to get worried”!!!

I have recently been diagnosed with type 2, and without the regular testing i did whilst i was going though my diet change, I would have no idea which foods caused high or low readings. I definitely think regular testing gives you the ability to control your diabetes 100% more than with no testing and using the 3 month HBA1c tests.

[impressive self-experimentation:] For my own edification, I discovered that chromium, zinc, and vitamin B1 added to my diet were benficial. I discovered that cinnamon, selenium, Omega 3, and some other quack remedies being touted on the web did nothing for me except empty my pocket. I was about to start investigating CQ10 enzymes, but the doctor [who said “don’t self-test”] stopped that trial in its tracks.

The most noticeable thing about this thread is how many people have either just joined or made a relatively “early” post after belonging for ages. Amazing! There is a depth of feeling aroused [by this report] that wasn’t apparent before!

Why have dermatologists claimed we can’t say acne is caused by diet (“there is insufficient evidence”)? Why did these diabetes researchers claim we can’t say home testing helps Type 2 diabetics? A big reason, I believe, is that these claims (if true, which they aren’t) would preserve their gatekeeper function. You don’t need to see a dermatologist to stop eating chocolate. Home testing will reveal all sorts of simple ways that you can control your blood sugar without medicine. The doctors who reach these ridiculous conclusions have a big conflict of interest that goes unstated. They are fine with the conclusion that home testing helps Type 1 diabetics because Type 1s will still need them. Because Type 1 diabetics inject insulin, they need doctors to prescribe it.

“The 11 Best Foods You Aren’t Eating”

Seth Roberts25 Comments

There isn’t one fermented food on a list of “the 11 best foods you aren’t eating” compiled by Tara Parker-Pope, author of the world’s most visible health blog. Nor do any of the listed foods contain animal fat. One of them (sardines) is high in omega-3, so the list gets a D instead of an F. Fermented foods and animal fat (in sufficient quantity) have easily-noticed benefits, in contrast to every food on the list. Parker-Pope and the nutritionist she consulted (Jenny Bowden) have large gaps in their understanding of nutrition.

Even More Room For Improvement at the NY Times

Seth Roberts2 Comments

In a widely-emailed article about depression, Judith Warner, a former columnist at the New York Times, writes:

This is the big picture of mental health care in America: not perfectly healthy people popping pills for no reason, but people with real illnesses lacking access to care; facing barriers like ignorance, stigma and high prices; or finding care that is ineffective.

When Atul Gawande fails to mention prevention in a discussion of how to improve American health care . . . well, he’s a surgeon. Of course he has gatekeeper syndrome. What’s Judith Warner’s excuse? Judging from this article, the notion that depression might be prevented has not occurred to her.

The Post-It Restaurant

Seth Roberts1 Comment

Two of my students took me here, which one list said is the best fish restaurant in Beijing. (Based on our meal, that’s plausible.) Its specialty is grilled fish “Wushan style”. Wushan is a mountain, not a province (like Sichuan or Hunan), so the restaurant may have invented the term. The menu is short. There are a bunch of cold dishes and the grilled fish, which comes in seven different flavors (hot & spicy, chinese sauerkraut, etc.). Unlike any other Beijing restaurant I’ve been to, you need a reservation. (Call a week ahead.) The restaurant, which wasn’t large, was packed. The walls were covered with Post-It notes. One said: “I wish I find my dream girl and me and my friend Bob have a safe life.” Another said: “Very spicy, very tasty, makes me feel very good.” A third said: “We had to wait a long time, so we ate a lot.” I wrote one saying what one of my students suggested: “We didn’t have to wait a long time but we ate a lot anyway.”

The Limits of Expert Trial and Error

Seth Roberts19 Comments

Of course I loved this comment on a recent post of mine about how to flavor stuff:

I made a vegetable soup today spiced by small amounts of vegetable stock, hoi sin sauce, angostura bitters, lea & perrins worcestershire sauce, Kikkomann soy sauce, maggi wrze, marmite, maille mustard. I can honestly say it was the best tasting soup I, or any of my guests, can remember having been served.

I routinely make soups that taste clearly better than any of the thousands of soups I had before I figured out the secret. There is no failure (I’ve done it 20-odd times), no worry about over- or under-cooking. Something else odd: There seems to be a ceiling effect. The texture could be better, the appearance could be much better, the creaminess could be better, sometimes the temperature could be better, the sourness could be better, but I can’t imagine it could be more delicious.
Why wasn’t this figured out earlier? I’ve looked at hundreds of cookbooks and thousands of recipes. I haven’t seen one that combines three or more sources of great complexity, as I do and the commenter did. There may be more trial and error surrounding cooking than anything else in human life. Billions of meals, day after day.

I think it goes back to my old comment (derived from Jane Jacobs) that farmers didn’t invent tractors. Some people claimed they did but I think we can all agree farmers didn’t invent the engine on which tractors are based. You can’t get to tractors from trial and error around pre-tractor farming methods. Even though farmers are expert at farming. I think that’s what happened here. I am not a food professional or even a skilled cook. My expertise is in psychology (especially psychology and food). Wondering why we like umami, sour, and complex flavors led me to a theory (the umami hypothesis) that led me to a new idea about how to cook.

And this goes back to what many people, including Atul Gawande, fail to understand about how to improve our healthcare system. The supposed experts, with their vast credentials, can’t fix it — just as farmers couldn’t invent tractors. Impossible. The experts (doctors, medical school professors, drug companies, alternative healers) have a serious case of gatekeeper syndrome. The really big improvements will come from outsiders. Outsiders who benefit from change. To fix our healthcare system, empower them.

“Two or Three Sentences That Go Together”

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In the latest episode of This American Life, devoted to 2010 predictions, a sixth-grade teacher says she would like one of her students to become a better writer. His essays are disorganized. “I would like Lewis to write two or three sentences that go together and make sense,” she said.

In the latest issue of The New Yorker, a profile of Supreme Court Justice Sonia Sotomayor by Lauren Collins contains this paragraph:

Perhaps in an effort to absorb quickly the mores of the Court, Sotomayor has hired experienced clerks, including one who spent the past year clerking for Justice Stevens and another who clerked for Justice Ginsburg. Near her desk is a framed cartoon by the Mexican-American illustrator Lalo Alcaraz. Against a lavender background, a girl with a pink bow in her dark hair sits at a desk, banging a gavel. A nameplate in front of her reads “Judge Lopez.” To her right is a makeshift witness box, inhabited by a Teddy bear. The jury box is full of stuffed animals. Taped to the wall behind her is a photograph of Justice Sonia Sotomayor.

The first sentence (“Perhaps in an effort . . . “) and the rest of the paragraph (“Near her desk . . . “) don’t go together. I suppose Collins or her editor liked the cartoon detail but didn’t have a good place to put it. So they put it here, at the end of a section.

The whole profile is more great work from Lauren Collins. The impressive thing about Sotomayor, someone tells Collins, isn’t that she’s the first Latina Justice, it’s that she’s the first Justice to grow up in a housing project. To good writing based on lots of work, Collins adds interesting observations:

In a profession that values the illusion of infallibility, Sotomayor has been unusually willing to acknowledge murky areas.

We want stories with heroes and villains. We want moralizing, in other words. In this sentence, Collins calls the legal profession bad and Sotomayor good.